In order to be eligible for federal financial participation (FFP), Specialized Services must be included in the State Plan.
To understand what PASRR activities cannot be claimed at the 75% Federal Financial Participation (FFP) match, one must first be clear on what activities are eligible for FFP.
Federal regulations give states the authority to claim FFP for administrative activates associated with the PASRR program included in their State Plan at Part §433.15(a)(9) of the CFR.
No, a nursing facility cannot perform a Level II pre-admission evaluation or resident review. 42 CFR §483.106(e)(iii) prohibits nursing facilities (or any entity th
According to §1903(a)(2)(C) of the Social Security Act and 42 CFR 433.15(b)(9), activities th
Yes, the CMS Long-Term Care Facility Resident Assessment Instrument (RAI) User’s Manual requires the NF to provide notification to the State-designated mental health (MH) or intellectual disability (ID) authority promptly
Level II evaluations for individuals with intellectual disabilities and/or related conditions:
Federal regulations governing PASRR do not specify restrictions on who can conduct Level I screens.
Part 42, Subpart C of the Code of Federal Regulations (CFR) contains the guiding regulations for PASRR compliance.
According to 42 CFR 483.106(a)(2), Basic Rule, the only true exemption from PASRR is the Exempted Hospital Discharge (EHD).
PASRR is guided by federal regulations that require: (1) all individuals being considered for admission to a Medicaid-certified nursing facility (NF) be screened prior to admissi
According to 42 CFR §483.106(b)(4) of the Code of Federal Regulations (CFR), when an individual is transferred from one nursing facility (NF) to another NF, with or without an intervening hospital stay, the individual is not considered a “new admission” and does not need preadmission screening.
Per Section 1919(e)(7)(B)(iii) of the Social Security Act, Resident Reviews are required for NF residents experiencing a “significant change in condition.” (Note that this provision replaced the requirement that PASRR Resident Reviews must b
Originally when the PASRR regulations were completed in 1992, Resident Reviews were required annually.
PASRR regulations at 42 CFR 483.128(m) permit Level II evaluations to be terminated if the Level II evaluator finds that individual has: “A primary diagnosis of dementia (including Alzheimer’s Disease or a related disorder)” (42 CFR 483.128(m)(2)(i)); or
States may apply the categorical determination at 42 CFR 483.130(h), to address a decision not to provide specialized services to individuals with dementia and intellectual disability. “(h) Categorical determinations: Dementia and ID.
The dementia exclusion for mental illness allows for the Level II evaluator to stop the evaluation if they determine that the diagnosis of dementia is primary and the mental illness (MI) diagnosis is secondary. It is important to note that the diagnosis or verification of a diagnosis of MI and...
Since the ICD-10-CM coding went into effect on October 1, 2015, some State PASRR programs have reported an increase in PASRR volume, particularly in referrals for Level II Resident Reviews. The increase is largely attributed to the computer algorithm that converted ICD-9 codes to ICD-10 codes.
There is a common misconception about this. The simple answer is "no" -- a test of intllectual functioning is not required. Here's the reasoning, broken down into its components:
Yes, hospitals can perform Level II evaluations -- provided they have the qualified staff. In order to complete these evaluations, hospitals would first have to negotiate payment rates with the relevant state agency.